As the home of cooked breakfasts and pints of beer, it is perhaps no surprise that Britain is the European king of anti-cholesterol drugs with some seven million users.
But recommendations to widen the use of "statins"—the class of drugs used to battle cholesterol—has sparked a national debate about their merits and whether they are really a silver bullet to stave off heart attacks.
Britain is the heaviest country in Europe, and the seventh fattest of developed countries worldwide, with OECD data showing 24.8 percent of adults are obese.
Britons also drink more than most rich nations and despite exercising more than most, the incidence of heart attacks is only slightly below the OECD average.
Alwyn Daniel, a 53-year-old from London, was put on statins two years ago after a visit to the doctor revealed a sudden jump in his cholesterol levels.
"My father died at 62 of a heart attack, so I started taking it because the doctor thought it might be a good idea," Daniel told AFP.
Seven million and counting
Statins inhibit HMG-CoA, an enzyme in the liver involved in producing cholesterol.
Ten years ago, statins were only prescribed to people in Britain who had a 30-percent chance of suffering a heart attack in the next decade, but their use has become more widespread.
The threshold is now 20 percent and NICE, the body responsible for regulating standards in the state-run National Health Service, recently recommended it be lowered to 10 percent.
This would increase the number of patients from seven to 12 million, or one in four adults.
Britain already consumes more statins than any other European nation, and only slightly less than Australia, which has the highest rate of use among OECD nations.
"The main reason they are so widely prescribed is because the evidence shows that they are very effective," said Maureen Talbot, nurse manager at the British Heart Foundation (BHF) charity.
The risk of suffering a heart attack is calculated using a wide range of variables, from age, weight and height, to family history and lifestyle factors, including cholesterol.
During a recent medical consultation in London, an AFP reporter was told he had a 12-percent risk of having some cardiovascular disease in the next 10 years.
"It would lower to nine percent if you were on statins," the doctor said. "But before (taking them), stop smoking—it would lower to 7-8 percent."
Critics say statins are being prescribed too easily, and that people should be asked to change their behaviour before turning to medication.
"I'm sure there would be a group of people that think that statins cure all evils and they can do what they like," the BHF's Talbot said.
"But I would say they are a small minority. The majority of people, if they are taking a tablet, will make changes in their lifestyle."
Daniel, the Londoner, insisted he did not see statins as a licence to eat whatever he wanted. "I don't have a cream cake just because I am taking statins," he said.
There are concerns about the potential side effects of the drugs, which range from nosebleeds, joint pain and nausea, to liver problems and an increased risk of diabetes.
Christophe, a 54-year-old Frenchman who declined to give his surname, starting taking statins six years ago but stopped a few months later after being diagnosed with hepatitis—which he says was unrelated to the statins.
After the problem with his liver was resolved, he went back on statins because his cholesterol was very high.
"I have had a bit of nausea, but nothing major. Two months after taking them, my cholesterol was down to normal levels, so it works," Christophe told AFP.
English breakfast 'is OK'
The new NICE guidance has reignited the debate in Britain over the merits of statins.
Two articles appeared in the British Medical Journal questioning the use of the drugs, only to be condemned as a "disservice to British and international medicine" by leading statins specialist Rory Collins, of Oxford University.
Meanwhile a vascular surgeon, Haroun Gajraj, wrote an article explaining why he had given up statins after eight years—and believed cholesterol levels were "all but irrelevant".
"Yes, it may, in some circumstances, be an indicator of heart disease but there is no evidence of a causal link," he wrote in the Daily Telegraph newspaper.
Gajraj said that since coming off statins, he had cut out sugar but increased his intake of butter, eggs and red meat—the components of a good English breakfast, and all blamed for high cholesterol. His levels had stayed down.
He has come round to the view of the Weston A. Price Foundation, a charity which advocates a natural diet and warns that the real evil is processed food and hydrogenated fats.
Eggs, milk and cheese were "foods that our ancestors considered important for having healthy children and avoiding disease", but have now been demonised by the "diet-ocrats", foundation spokesman Philip Ridley said.
While the debate rages, many patients are sticking by their medication.
"It doesn't take much to take a pill every day, does it?" said Daniel, while Christophe added: "I think it is better to take preventive pills than have a heart attack."
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